CAJ | 학술논문

　　目的分析探讨髌骨粉碎性骨折的手术治疗方法及临床效果。方法回顾性分析2007年2月至2012年3月我科治疗髌骨粉碎性骨折18例，其中男13例，女5例；年龄20～61岁，平均41岁；按照王鹏建等的髌骨骨折分型方法，其中 III A 型11例，III B 型6例，III C 型1例。所有病例均采用切开复位张力带钢丝加多针环形钢丝内固定手术方式治疗。术后每月门诊复查X线片并指导康复锻炼。通过对手术时间、髌骨关节面平整度、术后开始活动时间、术后随访有无复位丢失、切口愈合时间、骨折愈合时间及膝关节功能等指标的观察评定治疗效果。结果本组18例患者均获得随访，随访时间6～24个月，平均16个月。手术时间为100～150 min，平均120 min。术中透视及术后X线片显示髌骨关节面平整度满意。术后3天均开始逐步功能锻炼，术后12～14天拆线，无切口感染和愈合不良。术后随访X线片均无复位丢失，所有骨折均骨性愈合，骨愈合时间6～11周，平均9周。按陆裕朴膝关节功能评定标准评定：优10例、良6例、可2例，优良率为88.9%。结论张力带钢丝能维持坚强牢固固定以利于术后早期活动，多针使环形钢丝和张力带钢丝有所依托，环形钢丝保证了良好复位和防止复位丢失。张力带钢丝加多针环形钢丝固定治疗髌骨粉碎性骨折操作简单、固定可靠、可早期功能锻炼、效果确切，为治疗髌骨粉碎性骨折的有效方法。
　　목적분석탐토빈골분쇄성골절적수술치료방법급림상효과。방법회고성분석2007년2월지2012년3월아과치료빈골분쇄성골절18례，기중남13례，녀5례；년령20～61세，평균41세；안조왕붕건등적빈골골절분형방법，기중 III A 형11례，III B 형6례，III C 형1례。소유병례균채용절개복위장력대강사가다침배형강사내고정수술방식치료。술후매월문진복사X선편병지도강복단련。통과대수술시간、빈골관절면평정도、술후개시활동시간、술후수방유무복위주실、절구유합시간、골절유합시간급슬관절공능등지표적관찰평정치료효과。결과본조18례환자균획득수방，수방시간6～24개월，평균16개월。수술시간위100～150 min，평균120 min。술중투시급술후X선편현시빈골관절면평정도만의。술후3천균개시축보공능단련，술후12～14천탁선，무절구감염화유합불량。술후수방X선편균무복위주실，소유골절균골성유합，골유합시간6～11주，평균9주。안륙유박슬관절공능평정표준평정：우10례、량6례、가2례，우량솔위88.9%。결론장력대강사능유지견강뢰고고정이리우술후조기활동，다침사배형강사화장력대강사유소의탁，배형강사보증료량호복위화방지복위주실。장력대강사가다침배형강사고정치료빈골분쇄성골절조작간단、고정가고、가조기공능단련、효과학절，위치료빈골분쇄성골절적유효방법。
Objective To analyze and explore the surgical treatment methods and clinical outcomes of comminuted fractures of the patella. Methods The data of 18 patients with comminuted fractures of the patella who were treated in our department from February 2007 to March 2012 were retrospectively analyzed. Among them, there were 13 males and 5 females, whose average age was 41 years old ( range;20-61 years ). According to the classification of comminuted fractures of the patella made by Pengjian Wang and so on, 11 patients were at III A, 6 patients at III B and 1 patient at III C. All patients underwent open reduction and internal fixation with tension band, multiple K-wire and annular steel-wire. The X-rays of the patients were reviewed in the clinic monthly after the operation, and rehabilitation exercises were introduced to them. The treatment outcomes were measured by the operation time, flatness of the patellar articular surfaces, start time after the operation, loss of reduction during the follow-up postoperatively, surgical incision healing time, bone fracture healing time, function of the knee joints and so on. Results All the 18 patients were followed up for an average period of 16 months ( range;6-24 months ). The average operation time was 120 min ( range;100-150 min ). The intraoperative fluoroscopy and postoperative X-rays showed the flatness of the patellar articular surfaces was satisfactory. Gradual functional exercises were started 3 days postoperatively. Sutures were removed 12-14 days postoperatively, with no surgical site infection or poor healing. The X-rays showed no loss of reduction during the follow-up postoperatively. Bone healing of the fractures was obtained in all the 18 patients after an average period of 9 weeks ( range; 6-11 weeks ). According to Yupu Lu’s standard of knee joint function evaluation, there were 10 excellent cases, 6 good and 2 fair, and the excellence and good rate was 88.9%. Conclusions Tension band can maintain the stabilization of the fractures, so as to improve the early postoperative activities. Multiple K-wire can prop annular steel-wire and tension band up. Annular steel-wire can ensure good reduction and prevent its loss. Internal fixation with tension band, multiple K-wire and annular steel-wire is an effective treatment method for comminuted fractures of the patella, with the advantages of simple operation, reliable fixation, early functional exercises and exact effects.